ADOLESCENCE is a challenging crossroad between childhood and the adult world. It is that opportune time in an individual’s life when he or she learns to make choices based on experience, skills and values gathered in this period. Many kids announce the onset of adolescence with a dramatic change in behavior. Adolescence is also the time when a fast-paced family lifestyle, school, peer pressure, conflicting emotions including a sense of isolation, a need to experiment push an adolescent to drugs, alcohol and unsafe sexual behavior. Parents, schools and the community at large share the responsibility of harnessing an adolescent’s potential for the betterment of self and society. Arab Time spoke to the Medical Director of Yiaco Apollo Medical Center Dr Bhaskar Gupta, a Specialist Pediatrician and Neonatologist about the threat of substance abuse, violence and sexual experimentation among adolescents. According to him, alcohol and substance abuse is highly prevalent among young people.
In Insight today Dr Gupta talks of controlling impulsivity among adolescents, and ways for parents to recognize problematic behaviour in their adolescent children.
Question: What are the problems one notices during adolescence? Are these problems interlinked?
Answer: Adolescence is a period of rapid physical, emotional and mental growth and abilities. This is a period of risk-taking behavior and impulsiveness which gives way to many problems. As you know, adolescence constitutes around 18-20% of a population, which is the biggest golden asset for any community. Also, this is a group which does not like to visit a physician or counselor which results in masking the problems.
Carefree and irresponsible behavior may lead to many problems in this age group. The most frequently observed problems during this period are psychological disorders like anxiety and depression, violent behavior, eating disorders, sexually transmitted diseases and substance abuse. All these could be interlinked as the adolescent who wants to overcome one disorder tries another modality resulting in a worse outcome.
Q: So you mean to say while trying to overcome one disorder the adolescent may enter yet another behavior issue? Is this a vicious cycle?
A: Yes, this is a vicious cycle. A depressed adolescent may resort to drug abuse, and to satisfy his needs for this may resort to stealing and illegal activities. Many substance abusers may be drug dealers themselves. Thus anxiety, depression, violent behaviour and substance abuse may be interrelated.
Q: What is the cause for emotional instability among adolescents?
A: An adolescent can feel excitement gush through the veins during this period of rapid growth. A sense of independence and risk-taking behavior takes place during this period. There are also several physical changes in the body because of the interplay of various hormonal changes. With parents being regarded as greatest enemies who object and give their opinion in all matters, friends become their soul mates. This period is marked by increased emotional liability, hypothetical thinking and distraction resulting in many disorders. Also excessive competition, brilliant academic achievement and over-expectation by parents and lack of family support may contribute towards emotional instability.
Q: Competition has become all pervasive, in all fields of life including academics. Is this issue specially to do with families from South Asia? As a medical practitioner, did you ever feel that the ‘issues’ you mentioned is especially noticeable among certain communities?
A: Nowadays there is stiff competition to achieve the best in academics and on the professional front. Yes, problems of depression, anxiety and substance abuse is very much prevalent in families from South Asia, as those who are not able to cope with the stress resort to such behavioral disorders. As a practitioner, I have been dealing with these diseases which are there in all communities.
Q: How can parents recognize anxiety in their children and where should they seek help in Kuwait?
A: Anxiety is a natural and important emotion that human beings experience throughout their lives. When anxiety becomes severe in an adolescent affecting his social interactions, academic performance and his everyday activities, it needs treatment. The initial symptoms may be excessive worry and fear, nervousness, restlessness, extreme stress and dreams about a bad future. Anxious teenagers may appear dependent, withdrawn or uneasy. They may complain of physical symptoms like muscle tension, headaches, stomachaches, fatigue, hyperventilation and tremors. When parents notice any of these unusual symptoms in their teenage children, which is repetitive and progressive they should seek medical and psychological help. In Kuwait, there are many good facilities for counseling and therapy in the Government run Psychological medicine department as well as fully equipped private centers with psychiatrists and behavior therapists. These disorders can be very well treated with cognitive behavioral therapy, relaxation techniques, and family support and anti anxiety medications.
Q: You mentioned that adolescents can be treated with anti- anxiety drugs. Is it right to give such drugs to young people? Won’t they be hooked for life?
A: Anti anxiety drug is used only in severe cases where the basic treatment of behavioral and biofeedback techniques do not work and anxiety symptoms start taking a toll on the teenager. The medication is used under strict supervision by a psychiatrist, as a monotherapy or in combinations. When medications are used, the physician closely monitors for side effects. These medicines are used for a minimal time as needed. Most of the commonly used drugs are safe in adolescents and are not habit-forming. Thus, when used under strict supervision they are much more beneficial for adolescents and along with cognitive and psychotherapy ameliorates the symptoms.
Q: Is substance abuse also related to mental health disorder? Can depression lead to substance abuse among young people? How do we recognize symptoms of depression among the young and how do we help them?
A: Substance abuse is a very serious threat to the adolescent population and it is a result of several stressful factors including various mental health disorders. Depression is one disorder that results in substance abuse as a means to escape from reality. The symptoms of depression may be loss of interest and pleasure in usual activities, decreased food intake, inability to sleep or oversleeping, fatigue, feeling of hopelessness and thought of death. Depression may lead to falling school grades, school absenteeism, trying alcohol and drugs and suicidal tendencies. Depression is most noticeable by parents and close friends and develops over a period of weeks to months and needs treatment. Counselling, psychotherapy, family therapy and medications can help such adolescents.
Q: How big is the threat of substance abuse among adolescents in Kuwait?
A: The threat is significant in adolescents in Kuwait, given the fact that economic prosperity results in much illegal availability of these commonly used drugs in the country. According to WHO estimates, tobacco, alcohol and illicit drugs together contributed to about 12.4% of all deaths worldwide. An earlier study here showed almost 14% of college-going students had tried these substances at some stage of their college life. Adolescence is the stage when experimentation and later dependence on these begins, so definitely the threat is significant.
Q: Why do adolescents experiment with drugs and alcohol? Is it because they are curious and want to experiment with the unknown and they do not realize the potential threat? Do they do it for pleasure or peer pressure?
A: Adolescents abuse drug and alcohol due to many reasons, for instance, they want to fit in with friends or certain groups, or they believe it makes them more grown up or they like the way it makes them feel relaxed and euphoric. Curiosity, risk taking, escaping from reality, split and poor supporting families are some of the risk factors for this abusive behavior. Peer pressure forms an important factor in such experimentation. Adolescents with poor self esteem, emotional and mental health problems are at increased risk for substance abuse. Some teenagers try these substances a few times and then stop, but there are others who cannot control the urge and cravings and land up with drug dependence.
Q: Is substance abuse associated with violent disorders among adolescent or is violent disorder normal with most adolescents?
A: Substance abuse appears to be a major determinant of violence as it was found that 70% of violent crimes were associated with substance abuse. Normally boys are more aggressive as teenagers, but when violence results in dangerous activities, and then it indicates a serious underlying problem. Antisocial problems, property destruction, cruelty to animals, rape, armed robbery, use of weapons and fire settings are some of the violent disorders commonly found among adolescents. None of these violent disorders can be labeled as normal for any community worldwide.
Q: Is sexual disease also common among adolescents? Why is this so?
A: Yes, sexual diseases are also common in adolescents due to a variety of reasons like sexual experimentation, failure to use contraception, peer pressure, denial and not reporting to the physician any such illness. Diseases like gonorrhea, syphilis, chancroid, herpes, warts and HIV may result due to such behavior. Self treatment, peer group advice and improper medical care results in progression of such disease. There is a strong association between psychological disorders, substance abuse and sexual disease as one condition leads to another.